obacco control is an area where government policyinitiatives are uniquely effective in yielding wide-spread public health benefits. A decade ago, Canadaled the world in enacting tough and effective tobacco pol-icy regulations, particularly regarding warning labels ontobacco products. Since then, 38 other countries haveimplemented similar programs and many have far morestringent requirements.However, rather than moving Canada further ahead, thefederal government now seems poised to abandon this legacy.In late September, Health Canada abruptly announced at aclosed-door meeting with provincial and territorial representa-tives that it was suspending plans to move forward with largerand more graphic warning labels as well as a prominently dis-played toll-free number for a quit-smoking line. Instead, thefederal government’s tobacco policy will now focus on fight-ing contraband cigarettes.Warning labels are an effective, inexpensive communica-tion strategy. After television, labels are the most importantsource of information for smokers and nonsmokers alikeabout the adverse health consequences of smoking.
More-over, the “dose” of information increases in proportion to theamount of tobacco consumed: the more often smokers reachfor a cigarette, the more often they see and are influenced bythe warnings. And the tobacco industry is made to pay for it.Since Health Canada abandoned mass media campaignsagainst tobacco years ago, warning labels constitute the fed-eral government’s only remaining smoking-related masscommunication initiative.Warning labels make smokers substantially more likely tonotice and read messages about adverse consequences of smoking, to think about these consequences and about quit-ting, to forego a cigarette they were about to smoke, and to tryto avoid seeing the labels.
These cognitive and behaviouraleffects are in turn associated with increased rates of quittingsmoking.
Label messages also inform smokers about effec-tive strategies to help them quit. Regulations governing thesize and location of warning labels limit the tobacco indus-try’s ability to use labelling to providing misleading informa-tion and minimize the risks of smoking. Perhaps most impor-tant, warning labels effectively deter nonsmokers fromstarting to smoke and are a key medium for such messagesfor vulnerable children and youth.
The larger and more striking the labels, the more effectivethey are. Larger text messages are more successful thansmaller ones, and pictorial warnings are the most effective.
For this reason, guidelines issued by the international Frame-work Convention on Tobacco Control advocate large pictorialwarning labels.
Canada was the first country to implementlabelling regulations consistent with these guidelines. Theeffect on Canadian smokers has been rapid and striking. Forexample, knowledge of specific health consequences of smoking is twice as high among Canadian smokers comparedwith their counterparts in the US and UK, where warninglabels do not meet the guidelines.
The tobacco industry has argued that the existing warninglabels are sufficient, but as usual, they ignore clear evidenceto the contrary. Although warning labels are effective, theylose their effect over time and with repeated exposure. Coun-tries such as Thailand and Uruguay have refreshed their labelsthree or four times in the past five years. Canada’s labels haveremained unchanged for a decade. In fact, after years of research and millions of taxpayer dollars, Health Canada hasfailed to change a single label.The Harper government’s sudden policy shift is ill-conceived. At a minimum, the shift is wasting years of work and taxpayer dollars. Without warning labels, smoking rateswill rise and eventually result in increased smoking-relatedillness and death. Certainly, the problem of contraband mustbe addressed. However, there is no obvious reason why fight-ing contraband should stop the government from proceedingwith new warning labels that have already been developedand extensively researched.In the absence of a logical explanation, Canadians shouldbe forgiven for questioning the government’s motives. Manyhave speculated that the government has caved in to thetobacco industry,
that undoubtedly sees new and larger warn-ing labels as a potential threat to its markets and bottom line.In the past, tobacco companies have spared no expense tolobby and mount legal challenges to reverse government anti-tobacco policy. Others may see the policy shift as anotherexample of the Harper government’s ignoring public health tofocus on a law-and-order agenda.The federal Minister of Health has previously shown lead-ership in getting tobacco control legislation passed throughParliament. Her leadership is needed again. MinisterAglukkaq must take action to ensure that the new warninglabels go forward without further delay. She should commitHealth Canada to an ongoing process of regular and timelyrenewal of the labels, given the clear evidence that this isnecessary. She should also give careful consideration to theinitiatives of other countries that have surpassed Canada’slead in fighting tobacco consumption, such as Australia’srecent decision to require plain packaging of cigarettes.
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The federal government’s senseless policy changeon tobacco warning labels
Early release, published at www.cmaj.ca on November 8, 2010. Subject to revision.